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first Modern Era: The Unity of the Humanities5. essential envoyer: The Humanities Renewed6. systems: mechanisms from the Adults that contained the WorldAppendix A. A delivery about MethodAppendix B. Rens Bod is a security at the Institute for Logic, Language and Computation at the University of Amsterdam. He is awarded no on astronomers and the science of the links.


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Ulrike Merk (concert guitarist, composer, musicologist) was born near Stuttgart and studied guitar with Prof. M. Rennert at the Hochschule der Künste Berlin (soloist examination) and with Prof. A. Gilardino (concert maturity) at the Accademia Superiore di Musica L. Perosi in Biella/Italy. Diploma Music Teacher Studies at the Hochschule der Künste Berlin. Participation in numerous master classes with R. Aussel, A. Pierri, Th. Müller-Pering, D. Russel and others.
Parallel to her guitar training, she studied composition with L. Scharpf and Prof. Dr. H. Fladt in Berlin and attended composition courses with Leo Brouwer and Frangis Ali-Sade. She received her Dr. phil. degree with a musical-analytical thesis at the UdK-Berlin.
As a soloist and chamber musician she gives concerts at home and abroad.
In 2002 she was awarded the prize of the city of Mannheim for her wind sextet "music for six" at the XII. International competition for female composers.
Award at the IX.Torneo Internazionale di Musica in Weimar with the actress Marjam Azemoun for "Platero y yo" by Mario Castelnuovo-Tedesco.
2005 Publication of the Early French Songs by Fanny Hensel born Mendelssohn as first edition with piano and as arrangement by Furore-Verlag Kassel. In October 2005 premiere of the adapted version at the Konzerthaus Berlin.
2008 CD release of Early French Songs with singer Anne-Lisa Nathan on ARS (Distribution Note1).
The compositions Labyrinth I for guitar ensemble and Vier Miniaturen for guitar trio are published by Neue Musik Berlin. Publication of Sephardic Songs at Doblinger Verlag, Vienna 2013. Lectureship 2003-2015 at the University of the Arts Berlin. Her dissertation "Musik aus Al-Andalus als Erneuerungs- und Inspirationsquelle für die Spanische Moderne" – Kontextualisierungen und Exemplarische Analysen des Gitarren-Repertoires is published by Sierke-Verlag, Göttingen.
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Immediate effects of a lumbar spine manipulation on pain sensitivity and postural control in individuals with nonspecific low back pain: a randomized controlled trial
Jefferson Fagundes Loss ORCID: orcid.org/0000-0001-5948-63571,
Luciano de Souza da Silva2,
Iã Ferreira Miranda1,
Sandro Groisman2,
Edgar Santiago Wagner Neto1,
Catiane Souza3 &
Cláudia Tarragô Candotti1
Chiropractic & Manual Therapies volume 28, Article number: 25 (2020) Cite this article
According to the American Physical Therapy Association, there is strong evidence to show that vertebral mobilization and manipulation procedures can be used to improve spinal and hip mobility and reduce pain and incapacity in low back pain patients that fit the clinical prediction rule. Objectives: To evaluate the immediate effects of high-velocity low-amplitude (HVLA) manipulation on pain and postural control parameters in individuals with nonspecific low back pain.
This study used a participant-blinded and assessor-blinded randomized controlled clinical trial involving a single session, in which 24 participants were randomly distributed into control (simulated manipulation) and intervention (HVLA lumbar manipulation) groups. The primary (pain: subjective pain intensity and pressure pain threshold) and secondary outcomes (postural control: ellipse area, center of pressure [COP] excursion, COP RMS velocity, and differences between the COP and center of projected gravity) were evaluated before and after the session using a numerical pain scale, algometer, and a force platform. For all outcomes, multiple mixed 2 (group) × 2 (time) ANOVAs were performed.
For the subjective pain intensity, only time was significant as a main effect, where pre-intervention presented a greater value then post-intervention (F [1.44] = 4.377; p = 0.042; r = 0.30). For the pressure pain threshold no significant effect was found. For the postural control parameters, as a main effect, only the ellipse area was significantly greater in the control group (F [1.44] = 6.760; p = 0.013; effect size = 0.36).
There was a reduction in subjective pain intensity, evaluated using a numerical scale, in both the intervention and control groups immediately after the intervention, suggesting that the spinal manipulation had a similar effect to the placebo procedure. No effect of HVLA lumbar manipulation was identified for postural control variables in either the intervention or control groups.
The study was registered at ClinicalTrials.gov under the number NCT02312778, registered at 14 September 2014.
Back pain affects the lives of millions of people and is a considerable financial burden for Western health care systems [1]. Thus, in many countries evidence-based clinical guidelines have been issued to standardize the management of low back pain [2]. The diagnostic and therapeutic recommendations contained in these guidelines are generally similar. However, there are some discrepancies for recommendations regarding spinal manipulation for low back pain.
The Orthopedic Section of the American Physical Therapy Association (APTA) is seeking to create evidence-based practice guidelines for the orthopedic physical therapy management of patients with musculoskeletal impairments [3]. According to APTA, there is strong evidence to show that vertebral mobilization and manipulation procedures can be used to improve spinal and hip mobility and reduce pain and incapacity in low back pain patients that fit the clinical prediction rule [4]. According to a recent systematic review, spinal manipulation produces similar effects to other therapies (i.e. non-drug: exercise; and drug treatments: non-steroidal anti-inflammatory drugs, analgesics) recommended for chronic low back pain, and it is better than non-recommended interventions (i.e. non-effective: light soft tissue massage, no treatment, waiting list control; and potentially even harmful treatments: electrotherapies) [5].
Back pain has been associated with altered motor control in the spinal erector muscles [6,7,8] and impaired proprioception in the spine [9, 10], hindering lumbar stability, body balance, posture, and postural control. Impaired detection of passive motion is seen in people with low back pain. This may be related to changes in the excitatory threshold of mechanoreceptors [10], which could explain these postural control deficits [11]. There is evidence that subjects with low back pain experience greater center of pressure (COP) oscillation [6, 11,12,13,14,15], suggesting that this pain affects the neuromuscular responses required to maintain balance. However, in a systematic review focused on the effects of manual therapy, the authors showed that there is little research to support the use of manual therapy for the improvement of postural stability [16]. They concluded that new controlled trials are needed to provide robust clinical evidence of whether manual therapy and manipulation play a role in improving postural stability and balance.
Traditionally, controlled trials that evaluate the effects of manipulations on pain have been assessed based on scales and/or instruments that measure the level of pain [17] and local hyperalgesia [18]. It has been theorised that spinal manipulation also acts on the excitatory threshold of the mechanoreceptors [1], which are fundamental for maintaining balance and posture [16], it seems possible that the effects of manipulation may be assessed based on COP variations. Hence, the aim of the present study is to evaluate the immediate effects of high-velocity low-amplitude (HVLA) lumbar manipulation on pain and COP in subjects with low back pain (LBP). We hypothesized that vertebral manipulation would reduce both pain levels and COP oscillation.
Trial design
The present study is reported in accordance with the TIDieR recommendations [19]. This HVLA lumbar manipulation in subjects with LBP study is a randomized controlled clinical trial involving a control group (CG) and intervention group (IG) with a 1:1 allocation rate. It was conducted between January and March of 2015 with the approval of the Ethics Committee of the Universidade Federal do Rio Grande do Sul (number 834.848/CAEE 36001414.2.0000.5347) and registered at ClinicalTrials.gov (NCT02312778), according to the CONSORT 2010 [20].
The participants were recruited through social media and newspapers as well as in physiotherapy clinics. Manual therapy studies use the clinical prediction rule to select and classify homogenous groups of participants that may benefit from the use of spinal manipulation as a therapeutic intervention [4, 21,22,23,24]. The spinal manipulation clinical prediction rule has five criteria: pain duration of less than 16 days, no symptoms distal to the knee, score less than 19 in the fears and beliefs questionnaire, spinal stiffness, and internal rotation of the hip greater than 35 degrees [4].
The inclusion criteria for the study were men and women between the ages of 20 and 60 years with daily or almost daily lumbar pain in the previous 3 months [25] and who met at least four of the five clinical prediction criteria for HVLA lumbar manipulation [4, 23]. The exclusion criteria were the presence of radiating lower back pain, neurological alteration in the lower limbs (sensitivity, muscle force, and/or patellar or Achilles reflexes), previous surgery, medical diagnosis of spondylolisthesis, spinal stenosis, inflammatory disease, cancer, lower limb musculoskeletal degenerative diseases, pregnancy, pathologies and/or medications that may affect balance, osteopenia and/or osteoporosis, and women over 50 who had not had a bone densitometry exam.
Prior to intervention, the most hypomobile vertebra within the L1 to L5 vertebral segment was identified in all the members of both groups, using the clinical posterior-anterior vertebral pressure test applied with the subjects in ventral decubitus. Testing was performed on the spinous processes of the vertebrae. The osteopath placed the hypothenar eminence of the hand over the spinous process of the vertebra to be tested and applied gentle but firm pressure on the spinous process. By doing so, the stiffness of each vertebra was judged as either normal, hypomobile, or hypermobile. Thus, the most hypomobile vertebra was identified by comparing the mobility of the vertebrae immediately above and below [4]. It is important to highlight that, while assessing for segmental hypomobility is common in manual therapy practice, this test has only fair inter- and intra-rater reliability (kappa <.40) [26].
Each subject from both the CG and IG received a single intervention. All interventions were conducted on an examination table, with the subject in right lateral decubitus (Fig 1) because assessment on that side presents better intra- and inter-reproducibility [27, 28]. All interventions were conducted by an osteopath with 3 years of experience, who had been trained to identify vertebral mobility and perform the spinal manipulation (HVLA).
Initial position for both IG and CG
The participants allocated to the CG received simulated manipulation with no intended therapeutic effect. The participants allocated to this group were positioned in the right lateral decubitus position with the left leg flexed at the hip and knee and the left foot resting in the right popliteal fossa without stretching the paravertebral tissues (Fig 2). The participant remained in the position for approximately 20 s without receiving the HVLA thrust, which is the average time required to carry out HVLA lumbar manipulation [29]. For the IG, the HVLA lumbar manipulation was conducted according to Gibbons and Tehan [30], by locating the hypomobile vertebra when performing the thrust (Fig 3). During the manipulation it was unnecessary to produce an audible 'pop' [31].
Final position for simulated manipulation of CG participants
Final position for manipulation of IG participants
Assessment of outcomes
All assessments were performed by the same assessor, following the same sequence, namely: numerical pain scale (subjective pain intensity), algometer (pressure pain threshold) and test on force platform (postural outcomes).
A self-reported 10-point-scale [32, 33] was used to assess the subjective pain intensity at rest. Pressure pain threshold (PPT) was assessed using a 10 kgf analogic pressure algometer (Wagner Instruments, Greenwich, CT-USA). The PPT was assessed on three sites: the lumbar spinal processes of the most hypomobile vertebra identified during the posterior-anterior vertebral pressure test; and bilaterally on the spinal erector muscle group, located 5 cm each side of the lumbar spinal processes [34]. The assessment was carried out with the participants lying in the prone position (Fig. 4), in accordance with the procedures used by Oliveira [34]. In short, the assessor pressed the algometer at a rate of approximately 0.5 kgf/s. Participants were asked to say "pain" when the sensation of pressure or discomfort became a clear sensation of pain. Three measurements were collected for each site at 30-s intervals. The average of three measures was used for data analysis. If the participant did not report pain at a force equivalent to 10 kgf, the test was interrupted and this value was considered the PPT. Prior to the assessment, the assessor performed 2 demonstrations of the procedure on the extensor muscles of the dominant forearm to ensure that the participant understood the test. While no information was found regarding the amount of difference between two assessments that should be considered clinically important using the analogic pressure algometer, van der Roer et al. [35] recommended that when using a self-reported 10-point-scale a difference of 2.5 points is clinically important.
Pressure pain threshold assessment
Considering the possibility that the excitatory threshold of the mechanoreceptors is influenced by spinal manipulation [1], a secondary outcome, postural control was assessed in two ways: based on the COP and the Center of Projected Gravity (COPG). A BTS P-6000 force platform (BTS Bioengineering, Milan-Italy) with a sampling frequency of 500 Hz was used to evaluate the COP.
To evaluate the COPG, the SMTS DX high-definition motion capture system (BTS Bioengineering, Milan-Italy), consisting of 10 infra-red cameras with a sampling frequency of 500 Hz and a spatial resolution of 4 megapixels, was used. First, the barycenter of four reflective markers placed on the anterior and posterior superior iliac spines were used to estimate the center of gravity. This method was adapted from the sacral method, which is used for walking [36, 37]. Then, the COPG was calculated by projecting the three-dimensional coordinates of the center of gravity onto the floor. The COP and COPG signals were smoothed using a fourth-order low-pass Butterworth filter with a cut-off frequency of 4 Hz [38]. The variables for postural control were [11]:
The difference between the COP and COPG curves, found using the Root Mean Square (RMS) value: this analysis represents the close relationship between the COP and COPG curves in the Anterior-Posterior (AP) and Mid-Lateral ML directions during semi-static erect posture.
Ellipse area: defined as the area representing the dispersion of the COP positions in the AP and ML directions, where 95% of the data (COP positions) are present [39]. The area represents the degree of stability of the subject; the larger the area, the lower the stability.
Total pressure center excursion: defined as the total distance travelled by the COP over a given time in the AP and ML directions [40].
RMS velocity: defined as the square root of the quadratic mean of the COP displacements divided by the time between two successive positions, in both the AP and ML directions [40].
Study procedures
The collection environment was controlled in order to avoid sound or visual stimuli that could affect the evaluation of the COP. The researcher reviewed the procedural instructions with each participant. In accordance with the guidelines from Zok et al. [41], the participants were instructed to "stand as still as possible and stare at the fixed target in front of you" while in the orthostatic position on the force platform, with their feet approximately shoulder-width apart and their arms resting at the side of the body. The subjects from both groups were asked to adopt a semi-static upright posture, which was held for 30 s, eyes open with the gaze fixed on an x-shaped marker placed 3 m in front of the platform at a height of 1.75 m from the ground.
The procedure was repeated three times, generating three curves both before and after the intervention for each group. The initial analyses were performed based on Curve 2, arbitrarily. If any problems were encountered when collecting Curve 2 (i.e. unwanted participant movements, noising signal, etc) then Curve 1 was used. If necessary, Curve 3 was used as the last option. If such problems persisted, the participant would be excluded.
When calculating the sample size, the subjective pain intensity was taken into account based on data from de Oliveira et al. [34], who also investigated the immediate effects of manipulative therapy in patients with low back pain. Using the G-Power software version 3.1.7 (Universität Kiel, Germany), the t-test family (means: difference between two dependent means – matched pairs), means and standard deviations pre- (6.07 ± 2.12) and post- (4.16 ± 2.34) intervention, and assuming a correlation between groups of 0.5, an effect size of 0.85 was determined. Thus, assuming an alpha of .05 and power (1-β) of 0.80, a total of 10 subjects per group was necessary. Assuming a loss of 20%, we decided on 12 subjects per group.
The group randomization was simple and was generated using Random Allocation Software (Informer Technologies, Inc.) by a researcher uninvolved in the subsequent research stages. This same researcher distributed the labels in sealed opaque envelopes, respecting the numbering on each label.
This study was participant-blinded and assessor-blinded. The participants did not know to which group they had been allocated. They were informed there would be two different interventions and that they would be offered an alternative intervention after the end of the study if they wished. Nobody asked for an alternative intervention. However, the participant-blinding was not formally assessed. The evaluators rating the variables were also blinded because they did not know which intervention the participants had received, since they were not present at the time of the individual interventions.
The first stage consisted of recruiting individuals and having them sign the consent form. Then, one of the researchers completed an assessment form containing items such as the participant's age, body mass, height (Parisian point equivalent to 0.66 cm), level of physical activity (considered when executed with guidance from a health professional and at least three time a week), and study eligibility criteria, including the clinical prediction rule.
In the second stage, the primary and secondary outcomes were evaluated prior to beginning the intervention. The third stage, consisting of the post-randomization intervention, was always performed by the same osteopath without the presence of any of the other researchers. The post-intervention evaluation was performed during the fourth stage. There was no interval between stages. The time between pre-intervention evaluation and intervention, and between intervention and post-intervention evaluation was just enough for the respective researchers to leave and enter the room.
The data normality was assessed using the Kolmogorov–Smirnov test. If the data distribution was normal, parametric tests were applied to analyze the data. For the variables with non-parametric distribution, transformations were performed (log [x], sqrt [x], 1/x, etc.). SPSS 22.0 software (IBM) was used with a significance value of 5%.
The descriptive variables were presented as the mean and standard deviation with a confidence interval of 95%. For all outcomes, multiple mixed two-way ANOVAs were performed, with the group (control or intervention) as the independent factor and time (pre- or post-intervention) as the repeated factor. Given that the statistical test for the primary outcome was different from that in the original pre-register, the G-Power software was used to calculate the posthoc power (1 – β). Effect size (r) was calculated using the square root of the partial-squared eta (sum of squares of the effect divided by the total sum of the squares of the evaluated effects plus the sum of the squares of the error of the evaluated effect) and was classified as small when r ≤ 0.10, average when 0.10 < r 0.30, and large when r = 0.50 [42, 43].
Of the first 33 individuals who were contacted and agreed to participate, nine were excluded, four because they presented radiating pain and five because of age. Thus, 24 individuals participated, 12 in the IG and 12 in the CG, with no sample losses during the survey (Fig 5). There was no statistically significant difference between-group (p ≥ 0.05) at pre-intervention according to the sample description data (Table 1).
Study flowchart
Table 1 Sample characteristics
When the subjective pain intensity was analyzed (Table 2) a significant time main effect was observed, where pre-intervention presented a greater value than post-intervention (F [1.44] = 4.377; p = 0.042; r = 0.30). There was no significant effect for the group factor (F [1.44] = 0.369; p = 0.547; r = 0.09) or for group*time interaction (F [1.44] = 0.223; p = 0.639; r = 0.07). The power (1 – β) was calculated as 96.0, 15.4 and 11.0% for time, group and group*time respectively.
Table 2 Comparison of pain (primary outcome) before and after intervention
Regarding the pressure pain threshold (Table 2), there was no significant effect for the group factor, time factor, or group*time interaction, in the lumbar spinal processes, on the left side or on the right side of the spinal erector muscle group. The power (1 – β) ranged between 5 and 27%.
When the COP was analyzed through the ellipse area (Table 3), a significant group main effect was observed, where the CG presented a larger area (F [1.44] = 6.760; p = 0.013; r = 0.36). There was no significant effect for the time factor (F [1.44] = 0.461; p = 0.501; r = 0.10) or for group*time interaction (F [1.44] = 0.567; p = 0.455; r = 0.11). Regarding the total COP excursion, COP RMS velocity, and differences between the COP and COPG in the AP and ML directions (Table 3), there was no significant effect for the group factor, time factor, or group*time interaction.
Table 3 Comparison of the postural parameters (secondary outcome) before and after intervention
The results show a significant reduction in subjective pain intensity for both the control and intervention groups when comparing pre- and post-intervention, with no difference between-groups. Nevertheless, the difference in subjective pain intensity was less than the recommended 2.5 points considered necessary for clinical importance [35]. Furthermore, the reduction in subjective pain intensity for the CG suggests the manipulation effect is similar to the placebo effect, which disagrees with the results reported by Rubinstein et al. [5] The reduction in subjective pain intensity found in the CG may be attributed to a placebo effect or possibly explained by the Hawthorne effect [44, 45]. Regarding the IG, corroborating reports have shown that there is a hypoalgesic effect immediately after HVLA manipulation in the lumbar region [46, 47].
Regarding pressure pain threshold, there was no significant increase in the pain threshold for either the IG or CG, which is similar to the results reported by Dorron et al. [48], confirming that manipulation would not have an immediate effect. However, Dorron et al. [48] did find significant differences in relation to the baseline when the pressure pain threshold was assessed 10, 20, and 30 min after the manipulation, with the pain threshold increasing up to 12%. Additionally, investigating different manipulations (large amplitude, small amplitude, and quasi-static) in asymptomatic subjects, Krouwel et al. [49] found an increase in the pain threshold immediately after manipulation, as did Millan et al. [50] who confirmed an effect of spinal manipulative therapy on the pressure pain threshold. However, in a recent systematic review, Aspinall et al. [51] reported that significant changes in the pressure pain threshold over time in low back pain populations are inconsistent. These results suggest that more studies are needed to understand the immediate effects of manipulation.
Regarding postural control, neither of the COP-related variables (ellipse area and total COP excursion) showed differences after the intervention (Table 3), which is consistent with results obtained by Goertz et al [52],. who found no changes in postural variables after lumbar manipulation. In our study there was a significant reduction in pain, which was not accompanied by a significant reduction in either the area of the ellipse or the COP velocity.
According to della Volpe et al., changes in postural strategy may underlie a dysfunction of the peripheral proprioceptive system or the central integration of proprioceptive information. Muscle pain may cause marked reduction of position sense, possibly through increased presynaptic inhibition of muscle afferents at the spinal level and/or by a down-regulation of cortical systems involved in proprioceptive processing [15]. Since our participants had pain and the subjective pain intensity was significantly reduced, we speculate that the pain level and/or the reduction in pain was insufficient to induce any alteration on postural variables. Furthermore, it is possible that our study was underpowered for the secondary outcome measures.
When the differences between the COP and COPG were analyzed in the pre- and post-intervention situations, there were no significant differences regardless of the group (Table 3). However, while on average there is no difference between the pre- and post-intervention evaluations, some individuals demonstrated considerable changes in relation to differences between the COP and COPG. This variable would seem to be worthy of greater attention.
This study has several limitations. The first is related to the study design, which include only a single intervention and no follow-ups. Secondly, the limited sampling duration for the standing balance trials could be considered a potential study limitation. Thirdly, the participant-blinding was not formally assessed, which means there is no guarantee the participants were unaware the nature of the intervention they received (placebo or real). Another limitation refers to the sample size calculation, which only considered the subjective pain intensity. This fact may have under-powered our study for secondary outcome measures. Probably the main limitation is related to the sample size calculation, which we had assumed within-group comparisons. Thus, the results regarding the between-group comparisons are underpowered. In other words, our results regarding the lack of difference between groups need to be interpreted with caution (type II error possibility).
HVLA lumbar manipulation in subjects with LBP showed no intervention-specific effects on subjective pain intensity or pressure pain threshold. However, there was a reduction in subjective pain intensity, in both the IG and CG immediately after the intervention, suggesting that the spinal manipulation had a similar effect to the placebo procedure. No effect was found for HVLA lumbar manipulation on postural control variables over time or as a function of group allocation, which raises the possibility that either HVLA does not influence posture or that this study was insufficiently powered to detect any effect.
All data generated or analysed during this study are included in this published article [and its supplementary information files].
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No funding was received.
Universidade Federal do Rio Grande do Sul, Escola de Educação Física, Fisioterapia e Dança, Felizardo, 750 – LAPEX Building, Porto Alegre, RS, 90690-200, Brazil
Jefferson Fagundes Loss, Iã Ferreira Miranda, Edgar Santiago Wagner Neto & Cláudia Tarragô Candotti
Instituto Brasileiro de Osteopatia, Porto Alegre, Brazil
Luciano de Souza da Silva & Sandro Groisman
Faculdade Social da Bahia, Salvador, Brazil
Catiane Souza
Jefferson Fagundes Loss
Luciano de Souza da Silva
Iã Ferreira Miranda
Sandro Groisman
Edgar Santiago Wagner Neto
Cláudia Tarragô Candotti
JFL concepted and designed the study; analyzed and interpreted the patient data. LSS concepted and designed the study; recruited the participants. IFM collected a self-reported 10 point scale of pain. SG performed the interventions. ESWN assessed the pain pressure threshold on the lumbar spinal processes and the postural control variables. CS allocated the participants in intervention or control group. CTC concepted and designed the study; together with JFL, were the main contributors in writing the manuscript. All authors read and approved the final manuscript.
Correspondence to Jefferson Fagundes Loss.
The study was approved by Ethics Committee of the Universidade Federal do Rio Grande do Sul, register number CAEE 36001414.2.0000.5347, approved number number 834.848. All individuals signed an informed consent form agreeing with their participation.
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Fagundes Loss, J., de Souza da Silva, L., Ferreira Miranda, I. et al. Immediate effects of a lumbar spine manipulation on pain sensitivity and postural control in individuals with nonspecific low back pain: a randomized controlled trial. Chiropr Man Therap 28, 25 (2020). https://doi.org/10.1186/s12998-020-00316-7
Non-specific low back pain
HVLA lumbar manipulation
Numerical pain rating scale
Algometry
Postural parameters


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Employing nearly 3,200 people, BGE takes pride in its role as a community builder. The company works closely with the United Way of Central Maryland to foster community development through charitable outreach work in health and human services as well as after-school programming. A vibrant community depends on many strands of investment, so BGE helps to strengthen the arts and culture through local music and film festivals, regional theater productions, and multicultural education opportunities.
BGE also shows its commitment to Baltimore-area children in many ways. The new Energizing Student Potential (ESP) program, launching this fall, is designed to bolster STEM education in Baltimore County by empowering teachers to explore energy-related STEM subjects and introduce students to careers in energy technologies. Ten Baltimore County schools will pilot the program for 5th–8th graders. High schoolers are invited to participate in the biannual Youth Energy Conference and to apply for summer internship positions. BGE hired 50 summer interns in 2018 alone. The company's Frank Heintz Scholarship Fund annually awards $5,000 to nine local high school seniors and graduates based on their academic achievement and community service participation. Students are encouraged to apply for this award during all four years of attending an accredited institution of higher learning.
Equally important to BGE's mission is encouraging its employees to be actively involved in their community. In 2017, 25 BGE employees became "Bigs," accepting the responsibility to be a consistent presence in the lives of 25 "Littles," students at Maree G. Farring Elementary School in Baltimore, through the Big Brothers Big Sisters program. In this collaboration with the Y of Central Maryland, the Big volunteers meet twice monthly with their Little brothers and sisters in the BGE Spring Gardens complex, where they have lunch and discuss important life skills such as character development and even financial literacy. Not surprisingly, in 2018 the majority of the Bigs returned to mentor their Littles for another year. BGE's initial grant commitment spans three years, and the impact for all participants will last a lifetime.
The grant awarded to the Patterson Park Audubon Center Bird Ambassador program furthers BGE's support for ecological education. Established in 1867 and added to the National Registry of Historic Places in 2002, Patterson Park offers critical stopover habitat for neotropical songbirds migrating from Central and South America. The Patterson Park Audubon Center does much more than maintain this habitat, however. It also introduces Baltimore children and families to the magic in nature. The insight and appreciation gained by Patterson Park visitors can change lives. Hands-on exploration and education programs teach people how to green their own neighborhoods, be it by recycling more or adding butterfly and bird habitats in their backyards.
BGE remains a leader in environmental stewardship throughout Baltimore City and Maryland, offering Green Grants to nonprofits throughout the company's service area. The wide array of initiatives supported cover conservation, education, energy efficiency, pollution prevention, and community engagement. The grants range from $500 to $10,000. In 2018 BGE awarded $300,000 to 69 Maryland nonprofits. Recipients included Downtown Annapolis Partnership for public recycling, Irvine Nature Center supporting urban education initiatives, and the Herring Run Watershed's Baltimore Harbor Waterkeeper program, to name a few. Recycling and energy efficiency are also central to BGE's mission. The Exelon EcoTeam, an employee resource group, encourages volunteers in the business community to support green business practices. BGE employees have volunteered with numerous cleanup and recycling projects, as well as with Living Classrooms, Blue Water Baltimore, and Civic Works, among many others. In total, BGE employees commit an average of 26,000 volunteer hours annually throughout 11 counties in Maryland.
In addition to the money the company donates each year, BGE wanted to create the means for employees to support a cause that directly affects them or their loved ones. In 2015, the BGE Cause Initiative was established as a result. Every December, employees can nominate a cause associated with any nonprofit organization in the health and human services. BGE's management team reviews the three nonprofits that receive the most nominations and votes to select one.
In 2018, the BGE Cause Initiative was Susan G. Komen Race for the Cure. After the cause was selected, employees raised more than $290,000 for breast cancer research. More than 400 BGE employees and their families and friends participated in the Susan G. Komen Race for the Cure held on October 13 in Columbia, Maryland. The 2018 Cause Initiative was chaired by Valencia McClure, Vice President of Governmental and External Affairs, BGE; McClure is a breast cancer survivor and member of the Susan G. Komen Maryland board of directors. Funds were raised during the Race for the Cure walk and through company fundraisers and BGE's annual Smart Energy Open Golf Tournament.
In 2019, the BGE Cause Initiative will be supporting the Cal Ripken Sr. Foundation. This organization supports at-risk youth by developing life skills and a safe place for kids to grow and thrive.
Every BGE employee is a thread in his or her community's fabric. The company is proud to support the numerous organizations here that are working to improve life for Maryland residents, from the Greater Baltimore Urban League to the National Association of Women in Construction, from nutrition programs to first-responder support services. In short, BGE is committed to making Maryland a dynamic and healthy place to call home.


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Casio Exilim EX-FH100
Good quality at higher sensitivities for a compact, Useful zoom range, High speed video, High frame rate continuous shooting, Manual exposure control, Handling and build quality
Good photo quality at low ISOs, 10X, ultra wide 24 240 mm zoom lens in a compact, well built body, Sensorshift image stabilization, 3inch LCD has good outdoor and low light visibility, Tons of Best Shot (scene) modes, several of which are quite useful (e.
Flexible lens in a compact body; good control layout; useful and fun high-speed shooting options.
Auto focus can hunt at long end of the zoom, HS modes put large strain on the battery.
Details start to get smudged once you pass ISO 200, Redeye a problem, no removal tool available, Some corner blurring at wideangle, Didn't perform well in artificial light, even with custom white balance (won't affect most people), Very slow start
More Pros & Cons
Last revision on February 7, 2012
Good photo quality at low ISOs, 10X, ultra wide 24 240 mm zoom lens in a compact, well built body, Sensorshift image stabilization, 3inch LCD has good outdoor and low light visibility, Tons of Best Shot (scene) modes, several of which are quite useful (e
Flexible lens in a compact body; good control layout; useful and fun high-speed shooting options
Superb battery life, Sharp, wellexposed images, RAW shooting mode, Highspeed shooting mode for stills and video
Featurepacked, HD movie, 24240mm zoom range
Auto focus can hunt at long end of the zoom, HS modes put large strain on the battery
No fully automatic mode; mixed shooting performance; near-useless raw image capture
Takes time when saving RAW and highspeed shots, Laggy autofocus, Noisy lens motors, Limited fstop options in aperture priority
Low resolution highspeed movie, low LCD resolution, menu design, Raw shooting at ISO 100200 only
By Good Gear Guide on January 10, 2011 75
The Casio Exilim EX-FH100 is capable of capturing reasonably well defined photos, but it's not an excellent still image camera, merely a quite good one. Its best feature is the ability to shoot high-speed video, allowing you to capture scenes in...
By Expert Reviews on October 07, 2010 80
Beautiful photos and videos, backed up by a wide range of features including a 40fps burst mode and slow-motion videos....
By Trusted Reviews on September 21, 2010 90
Casio introduced its high-speed CMOS sensor technology with the revolutionary , launched just over two years ago. It followed it up early in 2009 with the premium ultra-compact, and the , a more compact super-zoom model. Having...
By ePHOTOzine on September 03, 2010 90
Creating a compact digital camera that stands out from the crowd can't be an easy task nowadays, but I feel that Casio have managed it this time with the EX-FH100.The camera provides god quality at high sensitivities for a compact, a useful zoom...
By cnet on July 17, 2010 73
The high-speed Casio Exilim EX-FH100 is a compelling compact megazoom camera for those constantly worried about missing a...
By CNET UK on July 09, 2010 83
The Casio Exilim EX-FH100's amazing high-speed shooting features make it unique among compact superzooms, but that's pretty much its only trick. The Panasonic Lumix DMC-TZ10, for example, costs about the same but has a better zoom, and is much...
By DigitalVersus on June 25, 2010 80
Focal length A nice feature of the FH100 is that it tells you the 35 mm equivalent of the focal length you're using, from 24 to 240 mm.This is much more useful than just giving a random number with no real meaning (as it's dependant on the wide...
By PC Advisor on June 18, 2010 70
The high-speed, energy-efficient Casio Exilim EX-FH100 is arguably the most versatile pocket megazoom around, thanks to its super-slow-motion shooting. The sacrifices here are lens control, a bit of video quality, and less-exciting scene modes than...
By infoSync World on June 17, 2010 69
This is the most fun we've ever had with a Casio digital camera since the rugged EX-G1, for this is a company that excels in opting for the path less traveled by. Heck, Fujifilm is ripping off Casio by implementing high-speed video on its...
By PCWorld on June 15, 2010 70
Casio's first high-speed pocket megazoom has superb battery life and image quality, but its noisy zooming and laggy autofocus are drawbacks....
By T3 Magazine on June 08, 2010 60
Feature-wise the Casio Exilim EX-FH100 has a lot to offer with its 10x zoom and super fast shooting. However, its disappointing image quality really lets it down. Still, it's a good compact for a sports...
By What Digital Camera on May 13, 2010 82
Feature-packed though the EX-FH100 is, and with great features such as both HD and high-speed movie, the whole package is just slightly short of the mark. The overall resulting image quality isn't bright, punchy or sharp enough at any of the ISO...
By PhotographyBLOG on May 12, 2010 80
The Casio EX-FH100 is a natural evolution of last year's EX-FC100 model, bringing together Casio's still-unique high-speed shooting options with an appealingly wide-angle 24mm, 10x zoom lens. With a multitude of different shooting options on...
By Amateur Photographer on January 01, 2010 60
Using the Exilim EX-FH100's high-speed continuous shooting mode is great fun and it enables users to capture images that would not normally be possible with a compact camera. Chromatic aberration and distortion are well controlled, especially...


Some of the accounts appearing in the year-end financial statements of Gino, Inc., appear below. This list includes all of the company's current assets and current liabilities.
a. Prepare a schedule of the company's current assets and current liabilities. Select the appropri- ate items from the above list.
Compute the current ratio and the amount of working capital. Explain how each of these measurements is computed. State, with reasons, whether you consider the company to be in a strong or weak current position.


Looking for an international phone card for overseas calling from Netherlands - Grave to Mexico? Comfi provides the best international calling cards that will make your connection with friends, family or co-workers profitable and impeccable.
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Sustainable product design for better built environments
Sustainable design is a commitment to the future—a lasting oath of guardianship over our environment. Throughout the product development process, every element of an object must be inspected for irrelevance and resource conservation. Is it appealing to trends? Is it destructive in material or manufacturing processes? Will it eventually end up in a landfill? An ideal ecological project should be long-lasting and inexpensive to build, but able to be recycled or returned completely to the earth when abandoned (Akadiri, Chinyio, & Olomolaiye, 2012).
By virtue of size, the construction industry is one of the largest consumers of energy, material resources, and water (Akadiri et al., 2012). Therefore, architects, designers, engineers, and other construction workers have a responsibility to reduce environmental impact through the implementation of sustainability objectives at the design and development stage of a project (Akadiri et al., 2012). Specifying sustainable products contributes to better built and natural environments, enhancing overall quality of life.
A case-study on sustainable design, the patented Cascade Expanding and Folding Screens are zero-waste, modular acoustic screens that function as spatial dividers and acoustic absorbers. Cascade Expanding Screens grow 100% in size when fully extended—without off-cuts or cut-outs—through a series of intricate cuts that form delicate patterns when pulled apart; a seamless marriage of aesthetics and practicality. This means that 100% of the panel is used, eliminating waste from the manufacturing equation. As the screens are made from lightweight, semi-rigid, needle-punched polyester fibre, the cuts—however slight—hold their shape whilst providing a pertinent level of flexibility. Similarly, Cascade Folding Screens have delicate cuts that form hinges from which cut-out shapes can be plucked, creating a three-dimensional feather-like texture. This not only increases surface area for acoustic performance, but adds a sleek sculptural element.
Open-plan environments can be an exercise in resource conservation, but often at detriment to the wellbeing of the inhabitants. Minimalism is, arguably, a double-edged sword. A vast, multi-purpose space with stripped back furnishings and exposed masonry is acoustically problematic and consequently unsustainable due to lowered quality of life. A perfect solution, Cascade acoustic screens effectively compartmentalise spaces, creating smaller manageable zones without sacrificing the open plan feel. Using less resources than other partition styles, Cascade screens contribute to dematerialisation whilst combatting echo and reverberation—a win-win for environments with a minimalist aesthetic.
While true sustainable design can feel unattainable in a world that still runs on fossil fuels, Akadiri et al. (2012) argue that "It is precisely at the micro-levels that sustainability objectives have to be translated into concrete practical actions, by using a holistic approach to facilitate decision making" (p. 127). With this in mind, architects and designers should feel encouraged to grasp the challenge of sustainable design with both hands.
Akadiri, P., Chinyio, E., & Olomolaiye, P. (2012). Design of a sustainable building: a conceptual framework for implementing sustainability in the building sector. Buildings 2012, 2, 126-152. doi:10.3390/buildings2020126
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Quicktime Pro - convert DV to H.264 BUT file won't play on iPod?
I have been trying to encode Microsoft DV or Pinnacle DV AVIs into MPEG4 (H.264) for iPod, BUT the resulting files do NOT play in an iPod!?
VIDEO: H.264 at 200kbps, Baseline Profile, 25fps, Auto Key Frames, 320x240 or 640x480, Multipass Best quality encoding.
AUDIO: AAC Audio at 96kbps, 24kHz sampling freq, Stereo.
I'm actually doing it for a client and they cannot play the file, they apparently have to 'convert' my file in their MAC based iTunes for it to work.
Anyhow can anyone please give me an idea if I am doing something wrong?
Do the files end with ".m4v"? If not, the iPod will not recognize them. I am not sure if 640x480 files will play on any but the most recently announced iPods.
The format has to be H.264 or MPEG-4. the File Extension has to be .m4v, and the Video has to be 320x240 and Audio has to be 48000hz or under.
You have to update the firmware of the ipod to play 640 x 480. Maybe that will help.
My client says his iPod can play m4v and mp4 files as long as they are iPod spec, I asked him to just rename the extension to see if it would work but no, his iTunes still had to convert my file for him to play it on his iPod.
My client's iPod is capable of playing 640x480, it is apparently one of the later models so that isn't the issue either.
This sounds like a good tip for perhaps 'older' iPods... but as mentioned above my client has no trouble playing the larger 640x480 files.
I can indeed export files for iPod in the default settings (in fact the options are greyed out so no adjustments can be made), but I always wanted to tweak settings so the files looks readable and don't take up much room.
The Quicktime Pro I bought is version 7.1 and if I export Movie to iPod then it spits out a pretty average file at 320x240 (and slides are unreadable) and it seems to do it quickly suggesting it only does a single pass. Along with that the data rate is up at 100KB/sec which is more than double of the file I have custom produced with multi-pass, my file's data rate was around 35KB/sec. However, I have come across an article stating that multi-pass 'can' allow peaks in the data rate which is what may be causing 'problems' for iPods as they have a limit of around 700KB/sec, but I'm not sure.
When I get time I will try to do a series of test files (10 secs or so) especially with different audio, I think this may still be a factor as I currently make them 24kHz / 96kbps and not 44.1kHz or 48kHz at up to 160kbps.
I've had a chance to make a few different sample files for iPod, hopefully one of these will work on a video ipod!
If someone has some spare time, could you please load into ipod (without conversion) to see if any of them will play? Then post your feedback.
Last edited by Jack Robertson; October 18th, 2006 at 10:28 AM.
I can try this for you, but I can't grab the files.
I have just tried to repair the links... (I had problems with hosting place).
If that won't work I can email them as they are small.


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Travel Information Expense Claim
By-Law Development
ISC Economic Development Funding Best Practices
Clean Energy for Indigenous Communities
Land Governance Under the Framework Agreement on First Nation Land Management
Cando Accredited Training: Aboriginal Law and Policies
Community Engagement - Tips, Techniques and Virtual Tools
Land Governance Authority, Committees and Priorities
Making Economic Resiliency and Recovery the New Norm
Separating Politics from Business
Appraisals on Reserve
Law Development and Enforcement for First Nations under the Framework Agreement
Additions to Reserve Policy Redesign
ISC Land Management Manual Update
FNHA Sewage 101
Additions to Reserve Policy Overview
Environmental Governance under Land Code
Separating Politics from Business (repeat)
Revitalizing Community Capacity in Agriculture & Food
Presenting Organization: NALMA
This course examines how First Nations may develop by-laws under the Indian Act to govern matters within their reserve. In this course we will examine:
Specific Indian Act requirements for approving a by-law, as well as the jurisdictional limitations of by-laws.
The process to develop, implement, enforce, amend, or repeal by-laws.
The differences between an Indian Act by-law, and other sources of by-law-making authority that a First Nation may have including the inherent authority of Indigenous peoples to have their own Indigenous laws. This will include an overview on enacting by-laws that incorporate overlapping sources of by-law-making authority.
Best practices and key considerations for First Nations to use in developing an Indian Act by-law.
Cynthia Westaway
Cynthia Westaway is Manager and Senior Counsel at the First Peoples Law office in Ottawa, Ontario and a Certified Specialist in Aboriginal Law with The Law Society. First Peoples Law represents Indigenous clients in consultation, rights, Title and Treaty, governance, and economic development matters. Cynthia brings significant law and governance experience from her previous work with various Canadian ministries, including as Director General of Legal Services at Global Affairs, and Senior Counsel at the Department of Justice. Cynthia served as a law clerk at both the Federal Court of Canada (with Justice Pinard) and at the Supreme Court of Canada (with Justice L'Heureux-Dubé). She holds a Masters degree in Comparative Aboriginal Law (US, Canada, New Zealand and Australia) from the University of Ottawa. Cynthia has been honoured to plead at the Supreme Court of Canada and has represented Indigenous clients on several key lands and environmental matters. She is excited to participate as a panelist at the CAFLP conference.
Conference Details
Westin Bayshore, Vancouver, BC
For more information contact: skonoval@edo.ca
or call 1-800-463-9300 x 231.
L2L Agenda
Tuesday, January 31, 2023 (Procurement Day)
8:30 - 8:45 am OPENING REMARKS
8:45 am - 9:45 am Plenary Session
9:45 am - 10:00 am HEALTH / NETWORKING BREAK
10:00 am - 11:15 am Workshops
11:15 am - 12:15 pm Workshops
12:15 pm - 12:45 pm Lunch
12:45 pm -1:15 pm Plenary Session
1:15 pm - 2:15 pm Workshops
2:15 pm - 2:30 pm HEALTH / NETWORKING BREAK
3:30 pm - 4:30 pm Closing Plenary Session
8:45 am - 10:15 am Workshops
10:15 am - 10:45 am HEALTH / NETWORKING BREAK
12:15 pm - 1:00 pm Lunch
1:00 pm - 1:30 pm KEYNOTE SPEAKER
5:00 pm - 6:30 pm Welcome Reception
1:00 pm - 1:30 pm CLOSING
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Just when I want to take some time to enjoy myself, it hits - a weekend headache. But why? What's causing it? Is this a unique headache all its own, or a symptom of some other problem? And what can I do to stop it?
It may help to know that this is a question researchers have asked as well. We don't have all the answers to the questions about weekend headache, but we've come a long way toward understanding what exactly is going on.
Just what kind of a headache is it? Well, it doesn't seem to be just one kind. If you have migraine disease, for example, and are prone to migraine attacks, you're likely to be having another migraine attack. The same goes for tension-type headache - they can be weekend headaches too. Check out this study about what weekend headaches are.
So it's important to look at the big picture. If you've been diagnosed with a certain type of headache or migraine, and these symptoms are similar, that's where you need to start.
Of course, if you're only getting headaches on the weekends, and don't have a diagnosis, you need to talk to your doctor. It's very important to check with a doctor who knows your medical history about any kind of headache you have, if you haven't talked to her about it before.
Some people, as we've said, are more susceptible to migraine or headache attacks than others. And believe it or not, there's still a lot we don't know about both migraine and tension-type headaches. It's been theorized that they may both stem from a common cause.
When your body is particularly prone to headaches, it's likely to be very sensitive to certain changes. Changes in food, sleeping habits, environment - many things can cause the change. Some people believe that a simple "stress let-down" triggers an attack - in other words, when you stop to relax after a busy week.
Change of sleep patterns: Yes, sleeping in - any change in sleep schedule, can trigger an attack. I know you don't want to do it, but you may need to get up at the same time every day, weekends included. Also, getting less or more sleep than usual may cause problems - staying up late for example. But some people find that they can get away with staying up late as long as they still get up on schedule.
Caffeine changes: You always have a cup of coffee when you get to work? But on the weekend, you're still sleeping at that time? Or maybe you get more caffeine on the weekend. Whether more or less, it could be the change that's triggering your weekend headache. The best answer may be to avoid the caffeine altogether, or at least cut down. But if you aren't going to go with that option, at least try to keep your caffeine intake steady.
Food/blood sugar: Changes in blood sugar levels can be major triggers. Some people find that they feel better if they always eat a healthy breakfast, and always at the same time - even if they go back to bed afterwards! Watch how your eating habits change on the weekend. Drinking wine? Significant diet change?
Environment: This is a wide topic, but think about how your environment changes on the weekend. Could that be triggering an attack?
Finding a trigger like those above may be your best treatment. However, if that doesn't work, and you're having an ongoing problem with headaches, don't ignore them. There is treatment available to help keep them away, and many people have found excellent solutions.
For more about treating migraine, try here. For more about tension type headaches, read here. For more about the link between migraine and tension-type headache, check here.
The National Headache Foundation has a short write-up about weekend headache here.


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HOME / PEOPLE / BRUNO LAUREATES PAGE / Shulamit Levenberg
Shulamit Levenberg
Professor Shulamit Levenberg is the dean of the Faculty of Biomedical Engineering at the Technion – Israel Institute of Technology. She also serves as the director of the Technion Center for 3D Bioprinting and The Rina and Avner Schneur Center for Diabetes Research. Prof. Levenberg earned her PhD at the Weizmann Institute of Science, and pursued her post-doctoral research in tissue engineering at Prof. Robert Langer's lab in MIT. In 2004, she joined the Technion, where she conducts interdisciplinary research on stem cells and tissue engineering.
Her groundbreaking discoveries involve in vitro vascularization of engineered tissues where, upon implantation, the engineered vessels anastomose with the host vasculature, improving survival and perfusion of engineered grafts. Prof. Levenberg was the first to engineer vascularized tissue flaps, offering novel reconstruction techniques using engineered tissue constructs. Her pioneering work demonstrated the effect of scaffold stiffness and tensile forces on early differentiation and organization of stem cells in 3D constructs, and on alignment of vessel networks in engineered tissues. She recently developed unique stem-cell engineered tissue constructs that induce the regeneration and repair of injured spinal cords.
Prof. Levenberg was named by Scientific American as a "Research Leader" in tissue engineering, for her seminal work on vascularization of engineered tissues. She is the recipient of numerous awards and accolades, including the Krill Prize for excellence in scientific research, awarded by the Wolf Foundation, the France-Israel Foundation Prize, the Italian Excellence for Israel Prize, the Teva Research Prize, the Juludan Research Prize, and the Rappaport Prize for Biomedical Sciences.